HomeMy WebLinkAbout166 '"� CITY OF DIAMOND BAR PRESS
DEPARTMENT OF BUILDING AND SAFETY
BUILDiNG PERMIT FIRMLY
JOBSITE APPUCATION PERMfT E
ADDRESS � 6 1300 S. Vallev Vist u�E —� TYPEER�,�CODE
4 APN LOT TRACT� DATE CONST.�L,L'�_ �,,,�
o CROSS STREET TBACKS .�wE►E�s
°-' OWNER P•K. Di�nond Vent�e o. L. . 20NlNG �� � ❑
o ADDRESS 818 W. 7th St. Suit� 700 , REAR �
W CITY � ��S ZIP �17 �213 623r10 SIDE% STRE'ET�'` � � .•' pW � ' ❑
Q APPLICAPIT TEL ❑
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6 CONTRACTOR �lvedere Pl�aohis�g �,c�
o ADDRESS 13350 Ector St. SEWAGE � PUBUC PMT#�
DISPOSAL ❑ pRIVATE SQ.FT./100 GAL
W CITY ��x'v ZIP 91746 TEL.�18
z STATE
y LIC.NUMBER GRAOING � CU.YDS.ExC. CU YOS FILL
y ARCH/ENG/ � NPE SQ FT �ACfC)R PS ADJ. AREANALIJATtON
`—' DESIGNER LLJ 1
o ADDRESS �W,,, 2
z CITY ZIP TEL. �r 3
� PROPOSED USE z a
� � GARAGE
= NO.DWEL. NO. NO. � ppRCH
y UNITS STORIES BEDROOMS m
� LOT DIMENSIONS VALUATION ADJ.AREA
o NO.OF BLDGS HOW ciUANTItY pESCRIPTION - FEE
W ON LOT USED
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LIC EO CO�TRACfORS OECLARATION I krehy dhrm IFet I am linn�ed uder pmvisions ol Chapler 9(commmtinp �
Y wrch Sectian 7000�of Oiwsnn 3 of the Busineas ond Professians Code.md my keroe it in hll krce wd dfat �
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_ OWNER�&11LOEH OECLABATION I heieby afhrm ffia�I am e�¢mpt Imm tAe Contrec�or'a Lkense la.r for tl�e Idlowing
z reasan ISec 7031.5.9usfnes�tnd Professions Cade�MY ciry or countY which requires a permrt ro construct. (�} � Vd�l@S . _ .
o alter,imp�ove.dema4sh,v repair any rtratwe,ryio�to its isswnee.dsn require�the epplsmt lor wch permrt �
Qto lile�sipned�teroment Met he ie licensed prawnt m Hw prwisio�s ol 1he ConhN[or'c lkenae law�Ch�p�er � _ �
s 9(mmmencing wifi Seuion 70�0)oF Oivisqn 3 d Me Business end Profeuions Codel m dnt he is emmpt iieielrom g
X and the 6�sis lar the dlegvd eampuon Any violuian of S¢tian 7091.5 by my�pplKant far�permil�uhjah � _
W the appl¢am Io�cinl pen�lly of mt rtpro th�n five hundred dollan(5500)�: ..1
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� ❑I,as owner ot tlie propeny,a my employees wnh wages�their sole eompenaeton,will Eo Ihe work,md 1
tM1e siructure ic rwt inuaded or afhrM lor ale(Sec 7066.Busin�ss�nd Prolesspns Code.The COntntMr's litense q
v Lew does rat apply to an o�wier ot prapeny wha 6wlds a impwes thereon,ond wM dces such wark himself, ()
W a throuqh his own employees,prwided Mat wch imprwamen(S efB n01 i1Rellded IX OHBfeC Mf 38h II,110WBVEf, �
= tM1e bmlding or�mDrwement is suld wuhin one yeer of comdetion.the owner�huilde�will heve me hurden ol pravi� ,�
N tM1a1 he did not hudd a�mprave for ehe purpoae o!ade.)
ti ❑1,as owner of ihe pmpany,am e�aMurvely connectmy with hcensed coMr�ctors to tonetiuct tFe prqat ISec �
� 1044,Busiress end Pm}essmns Code�The Contnc�or's l¢ense liw does mt�pply m�n owner o1 praperty who �
� Wilds ar imprwes thereon,en0 wha cantrecR fa�wch Orolects with�contractor�s)licenaed purwanl ro Ihe Contncta'�
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�"""��""� CONSTR UCTION
� ❑I�m erempt under Sec .B 5 P C.(Attach Giufieate� PLAN REVIEW
0 oaie owner ELECTRIC
yWDRNERS CUMPENSATqN DECLAqqTIpJ I herehy affem Ihat 1 hwe�cerof¢ate af crosent m ull�nswe,n .
e certficate o1 YNorka%Campenm�im In�wance,or a eenified copy ih�reot�Sec.98�0,1�6,C 1. � PLUMBING t��� ��'�""�
6 ❑Cerafiad copy�a herehy fumished � MECHANICAI.
c Certdied capy is Filed with Me Bwltlmp Inspecuon Oepanment or O�pximeM � GRADING
W �3 •�
� CEfiTIFCAiE OF E%EMPTION FROM WINiRERS'COMPENSATION INSURANGE.Thia secnon need nol 6e eompknd ISSUANCE
y d the permif n kr one hundred(Sf00)n I�a:.I eertily Ih�1 in Ihe Mdarmenee af tlie waY br whkh Ihia --
� perm�t is issued,I sAell Mt employ nry perEon in any menner io as l0 hetome whjat W�he Nbrkers'Campenatwn gMIP
= lews of Cddomre W
� PARK FEE �� � '
� �re �������� � u- SCHOOL FEES �''
� N0710E TO APPLICANT.N,al�er makinp tAia Caulcate of EremDtnn,yau shoul0 6ecome auhecl m Me Nfaker't ' �
—� Campensation pro�nsions of the Laha Cade,you must lathwi�h caroly xnM wch qmisiona w tl�ie pemul�h�ll
� he deemed revoked
�
p� OF INDUSTRIAI SAFETY PERMR CEpTIFICA710N:
W
o I Aere6y certity that no eMcavatian Mre�5)or mon leel in depih into wlxth�penan ia npwred m desemd. �
� dl made in connectian wiM work auMa¢ed hy Mia permit,pid thn m hmldinq ttructva,�ufloldinq,hlaework.
w demalman or dismonUinp tkreol,wtll be mare than tMrry-tu�36)feet hqh.(Chap 3.2.Grp 2,Art I,Sa
W x,.T�ues,e.a.ei. CITY OF DIAMDYiy`�laR '
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3 ❑as oW�,-wcwe�,i W�u���wr rwm w ao�,«k wnKn„�a�a����.oKmn r�m.nw��a BtiI�QING AND 5�4FE7`Y
� Intluseml S�h�y,os noted�Eo�re,unless tuch peRan hu�permN b Ao�uch wxk fian Me derisian i
�
W ❑a��z�����r���5�ry��m���a. TOTAL FEES . � �,��—
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� CONSTRUCfI�N LENUING AGENLY:1 here6y dti�m tlut Uero ia�eanstruc6on Ynduq pmry la tlu perlonnaxr
= of Ihe wark fa whuh thit qrme k uwed�See.3091,Gv.C�.
= lmder'a wme COMMENTS
pp LMdl1 3 flEOrE55
� CEfRIfCATE OF CpAPIIANCE ANO AUTF�NIATXIY OF EN7f1Y:1 arfily I hwa,ead tliis�pplintian 1nd u�h
� thet Me mlrcm�tian puen e earect 1 aprw to tomply w�h�A Wa Ywt ind eiry ordi�w¢a Naliiq l0 6uildinp
y canstructwn,end wthorim o npms awe d dr D�partmem d Buildinp ad Srhty m�br Ypon 1M peperry
� tar whch �e appled Ior l�is t Fa Me qryas mekmp imo one.
S1yna�ure al Applknt a Apem L J�—�J��ey� Olfe� RECPT NO.�„LJ/ —' — � . ' •
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